Mostashari: Pressure is on for efficiency

BOSTON—Risk aversion is entrenched in healthcare but opening up data could change that, according to Farzad Mostashari, MD, ScM, former national coordinator of health IT, speaking during the Digital Healthcare Innovation Summit.

During his tenure at the Office for the National Coordinator of Health IT (ONC), adoption of EHRs went from 8.8 percent in hospitals to 44 percent, which is as much progress each year as the 20 years prior.

The ONC also went from 32 people to 180 under Mostashari’s watch and started with a bare cupboard when it came to standards for health transactions. The office released a series of 42 different transaction standards. “Now, in the 2014 certification requirements, we have a pretty good starter set that will start to ease data siloes from a technical point of view,” he said.

But technology in and of itself doesn’t do anything, he added. The trick is making it actionable. “We’re more than halfway through digitizing healthcare processing but only 5 percent through redesigning healthcare to take advantage of those technologies. At its best, the EHR helps create an operating system and becomes the care team’s desktop. A lot can go on top and around that.”

Data becomes the oxygen for a whole lot of innovations, Mostashari said. Innovation can be accelerated and made possible with an increasing amount of “digital oxygen.”

The tension between innovation and regulation is working, partly because the government is leading by example, he said. Fear of HIPAA is preventing some innovation, he said, but people can guard against regulatory risk but understanding the regulations. A 617-page regulation probably spends the first 600 pages explaining why the government is doing this, he said. “There’s a role for demystifying what the regulators are thinking so innovators are not afraid.”

Mostashari is now visiting scholar at The Brookings Institution focusing on accountable care organizations (ACOs). He said this area interests him because “data is oxygen. Oxygen doesn’t burn—it has to be combined with fuel. It’s never about money and it’s always about money.” The Affordable Care Act is about getting coverage but also about moving the dial on how we pay for healthcare. He said he’s excited because 10 doctors represent $10 million in healthcare delivery. If that group can reduce their healthcare spending by 5 percent, that represents significant change.

Mostashari said he plans to create a set of policy recommendations on how to tweak regulations to make them more effective. “Legislation can be two sentences that turn into 600 pages of regulations. They can be fixed and improved over time. There are opportunities to fix any defects that are found. Before you can iterate, you have got to know what are the problems.” Mostashari said there are now 500 ACOs. The concept has “passed from the hands of policymakers to providers implementing.”

Companies that focus on access, quality and costs will probably do well, he said, and help providers deliver the care we already know is appropriate. Only 7 percent of people with diabetes are getting the right care, he said. “That’s criminal. There’s a whole world of know-how, tools and skills to help doctors, hospitals and patients get the basics right.” A lot of hospitals are talking about improving care delivery but not doing it, he said. “They’re milking the fee-for-service cash cow as hard as they can but people need to take a hard look at their costs. There are going to be a lot of pressures on hospitals to get those efficiencies.”